What is the dosing for Cardizem (Diltiazem)?

From the Guidelines

The dosing for Cardizem (Diltiazem) is 0.25-mg/kg IV bolus over 2 minutes, followed by an infusion at 5–10 mg/h, up to 15 mg/h.

Key Points

• The initial dose of Diltiazem is 0.25-mg/kg IV bolus over 2 minutes 1.
• The maintenance dose is 5–10 mg/h, up to 15 mg/h 1.
• Diltiazem can be used for stable, narrow-complex tachycardias if rhythm remains uncontrolled or unconverted by adenosine or vagal maneuvers, or if SVT is recurrent 1.
• Caution is advised when using Diltiazem in patients with AV block greater than first degree or SA node dysfunction, hypotension, decompensated systolic HF, or pre-excited AF or flutter 1.
• Diltiazem is a substrate of CYP3A4 (major) and a moderate CYP3A4 inhibitor, and should be used with caution in patients taking certain medications, such as apixaban, itraconazole, and cyclosporine 1.

From the FDA Drug Label

Diltiazem Hydrochloride Tablets: Diltiazem is absorbed from the tablet formulation to about 98% of a reference solution Single oral doses of 30 to 120 mg of diltiazem hydrochloride tablets result in detectable plasma levels within 30 to 60 minutes and peak plasma levels 2 to 4 hours after drug administration. As the dose of diltiazem hydrochloride tablets is increased from a daily dose of 120 mg (30 mg qid) to 240 mg (60 mg qid) daily, there is an increase in area-under-the-curve of 2. 3 times. When the dose is increased from 240 mg to 360 mg daily, there is an increase in area-under-the-curve of 1.8 times. The dosing for Cardizem (Diltiazem) is as follows:

• Single oral doses of 30 to 120 mg
• Daily doses of 120 mg (30 mg qid), 240 mg (60 mg qid), or 360 mg Key dosing information:
• Detectable plasma levels within 30 to 60 minutes
• Peak plasma levels 2 to 4 hours after drug administration 2

From the Research

Dosing for Cardizem (Diltiazem)

• The recommended starting dose for diltiazem is an intravenous bolus of 0.25 mg/kg over 2 minutes 3.
• A lower dose of diltiazem, such as 0.2 mg/kg, may be effective in controlling rapid atrial fibrillation and reduce the risk of hypotension 3.
• A standard dose of 10 mg diltiazem may be noninferior to weight-based dosing in the initial treatment of atrial fibrillation with rapid ventricular response 4.
• The median dose of oral diltiazem and IV continuous infusion diltiazem at four hours was 30 mg and 10 mg/h, respectively 5.
• Diltiazem bolus dosing ≥ 0.13 mg/kg was associated with significantly improved times to achieve heart rate control compared to < 0.13 mg/kg 6.

Weight-Based Dosing

• Weight-based dosing of diltiazem is recommended, with a dose range of 0.2-0.3 mg/kg 4, 6.
• A mean weight-based dose of diltiazem bolus of 0.13 mg/kg was associated with improved heart rate control 6.

Dosing Strategies

• Different dosing strategies for diltiazem have been compared, including weight-based dosing and standard dosing 5, 3, 4, 6.
• The choice of dosing strategy may depend on the individual patient and the clinical context 7.